Ulna Osteotomy System

ABSTRACT

A bone plate includes a first three-part combination hole extending through a proximal portion of the plate, a first portion configured to engage a threaded head portion of a bone fixation element, a second portion configured to receive a bone fixation element along an axis substantially perpendicular to a longitudinal axis of the bone and a third portion defining a screw axis extending toward the distal end of the elongated body at a non-perpendicular angle relative to the longitudinal axis in combination with a first two-part combination hole extending through the proximal portion, a first threaded portion configured to engage a threaded head portion of a bone fixation element and a second portion defining an elongated slot extending along a longitudinal axis of the plate for receiving a bone fixation element so that the plate may slide along its longitudinal axis relative to the bone fixation element.

PRIORITY CLAIM

The present application claims priority to U.S. Provisional ApplicationSer. No. 61/310,406 filed on Mar. 4, 2010 and entitled “Ulna OsteotomySystem,” the entire disclosure of which is incorporated herein byreference.

FIELD OF THE INVENTION

The present invention relates to systems and methods for performing anosteotomy and, in particular, an osteotomy plate and other devices suchas a drill guide for providing accurate alignment of cut portions of abone.

BACKGROUND

An osteotomy is a surgical procedure in which a bone is cut to shorten,lengthen and/or change an alignment of the bone. In particular, an ulnashortening osteotomy cuts the ulna to treat symptoms such as wrist pain,swelling, limited range of motion and diminished grip strength, whichmay result from conditions such as ulnar impaction syndrome. Ulnarimpaction syndrome is a degenerative condition related to excessive loadbearing across the ulnar aspect of the wrist and chronic impingement ofthe ulnar head against the TFCC, lunate and triquetrum. By shorteningthe ulna, impaction is reduced preventing wrist pain, swelling, etc.,such that function of the wrist joint is regained. Current ulnaosteotomy systems require complex surgical techniques with complexinstrumentation resulting in delayed unions or non-unions caused byinaccurate osteotomies and/or difficulty in maintaining bone alignment.In addition, the osteotomy systems often contain bulky instruments andimplants, resulting in hardware irritation and often, implant removal.

SUMMARY OF THE INVENTION

The present invention is directed to a bone plate, comprising anelongated body extending from a proximal end to a distal end andincluding a first surface which, when in an operative position, facesaway from a bone on which the plate is to be mounted and a secondsurface which, when in the operative position, faces the bone and afirst three-part combination hole extending through a proximal portionof the plate, a first portion of the first three-part combination holebeing threaded and configured to engage a threaded head portion of abone fixation element, a second portion thereof configured to receive abone fixation element along an axis substantially perpendicular to alongitudinal axis of the bone when the plate is mounted thereon in adesired orientation and a third portion defining a screw axis extendingfrom the second surface toward the distal end of the elongated body at anon-perpendicular angle relative to the longitudinal axis of the bonewhen the plate is mounted thereon in a desired orientation incombination with a first two-part combination hole extending through theproximal portion of the plate, a first threaded portion thereof beingconfigured to receive and engage a threaded head portion of a bonefixation element and a second portion thereof defining an elongated slotextending along a longitudinal axis of the plate for receiving a bonefixation element therethrough so that the plate may slide along itslongitudinal axis relative to the bone fixation element receivedtherethrough.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a top plan view of an osteotomy plate according to anexemplary embodiment of the present invention;

FIG. 2 shows an enlarged top view of a three-part hole of the plate ofFIG. 1;

FIG. 3 shows an enlarged bottom view of the three-part hole of FIG. 2;

FIG. 4 shows an enlarged cross-sectional view of the three-part hole ofFIG. 2, taken along line A-A;

FIG. 5A shows an enlarged top view of the three-part hole of FIG. 2including a bone fixation element inserted therethrough, in a firstconfiguration;

FIG. 5B shows an enlarged cross-sectional view of the three part holeand bone fixation element of FIG. 5A;

FIG. 6A shows an enlarged top view of the three-part hole of FIG. 2including a bone fixation element inserted therethrough, in a secondconfiguration;

FIG. 6B shows an enlarged cross-sectional view of the three-part holeand bone fixation element of FIG. 6A;

FIG. 7A shows an enlarged top view of the three-part hole of FIG. 2including a bone fixation element inserted therethrough, in a thirdconfiguration;

FIG. 7B shows an enlarged cross-sectional view of the three-part holeand bone fixation element of FIG. 7A;

FIG. 8 shows a top plan view of a further embodiment of the plate ofFIG. 1;

FIG. 9 shows a perspective view of an osteotomy plate according to analternate embodiment of the present invention;

FIG. 10 shows an enlarged perspective view of a three-part hole of theplate of FIG. 9;

FIG. 11 shows a perspective view of a drill template according to anexemplary embodiment of the present invention;

FIG. 12 shows a side view of a guide wire according to an exemplaryembodiment of the present invention;

FIG. 13 shows a perspective view of a saw guide according to anexemplary embodiment of the present invention;

FIG. 14 shows a perspective view of the saw guide of FIG. 13;

FIG. 15 shows a side view of a saw guide according to an alternateembodiment of the present invention;

FIG. 16 shows a perspective view of a saw blade according to anexemplary embodiment of the present invention;

FIG. 17 shows a perspective view of the drill template of FIG. 11mounted to a bone according to an exemplary embodiment of a surgicaltechnique of the present invention;

FIG. 18 shows a perspective view of the saw blade of FIG. 16 alignedwith transverse markings on the drill template according to theexemplary embodiment of FIG. 17;

FIG. 19 shows a perspective view of the saw guide of FIG. 14 mounted tothe drill template and aligned with oblique markings thereon accordingto the exemplary embodiment of FIG. 17;

FIG. 20 shows a side view of the plate of FIG. 1 positioned along thebone according to the exemplary embodiment of FIG. 17;

FIG. 21 shows a side view of a first bone fixation element inserted intothe plate according to the exemplary embodiment of FIG. 17;

FIG. 22 shows a side view of a second bone fixation element insertedinto the plate according to the exemplary embodiment of FIG. 17;

FIG. 23 shows a side view of third bone fixation element inserted intothe plate according to the exemplary embodiment of FIG. 17;

FIG. 24 shows a perspective view of the plate of FIG. 1, as used to fixa transverse cut of the bone according to the exemplary embodiment ofFIG. 17;

FIG. 25 shows a perspective view of the plate of FIG. 1 as used to fixan oblique cut of the bone according to the exemplary embodiment of FIG.17;

FIG. 26 shows a top plan view of a bone plate according to anotherexemplary embodiment of the present invention;

FIG. 27 shows a perspective view of a drill template mounted to a boneaccording to the exemplary embodiment of FIG. 26;

FIG. 28 shows a perspective view of a saw guide according to theexemplary embodiment of FIG. 26;

FIG. 29 shows a perspective view of the bone plate positioned along thebone according to the exemplary embodiment of FIG. 26:

FIG. 30 shows a perspective view of a compression of the bone accordingto the exemplary embodiment of FIG. 26;

FIG. 31 shows a perspective view of a bone fixation element insertedinto the bone plate of FIG. 26; and

FIG. 32 shows a perspective view of additional bone fixation elementsinserted into the bone plate of FIG. 26.

DETAILED DESCRIPTION

The present invention may be further understood with reference to thefollowing description and the appended drawings, wherein like elementsare referred to with the same reference numerals. The present inventionrelates to systems and methods for performing an osteotomy. Inparticular, exemplary embodiments describe an osteotomy plate and otherdevices such as a drill guide for providing accurate alignment of cutportions of a bone. It will be understood by those of skill in the artthat, although exemplary embodiments specifically describe an ulnarosteotomy, the present invention may be used for osteotomies of otherbones as well.

An osteotomy system according to a first exemplary embodiment comprisesan osteotomy plate 100, as shown in FIGS. 1-8, a drill template 200, asshown in FIG. 11 and a parallel saw 250, as shown in FIG. 16. The systemmay further comprise a saw guide 222, as shown in FIGS. 13-14 and aguide wire 240, as shown in FIG. 12. The plate 100 may be used to fixportions of a bone (e.g., the ulna) cut using the saw 250 and the drilltemplate 200 and/or the saw guide 222 as a guide. The drill template 200permits the bone to be pre-drilled, prior to cutting of the bone, withholes corresponding to the locations of openings in the plate 100. Thedrill template 200 may include markings indicating predefined shorteninglengths with holes arranged therein so that, when the template 200 isplaced over a target portion of the bone prior to cutting, the holes arealigned with positions which will correspond to the locations of holesin the plate 100 after a portion of the bone has been cut away andduring compression of the remaining pieces of bone into contact with oneanother. That is, the plate 100 includes 2 holes 138 including elongatedportions 142 which, when the plate 100 is placed on the bone in adesired orientation, extend substantially parallel to a compression axis(i.e., an axis along which the severed portions of bone will be movedtoward one another). Initial bone screws may be inserted through theholes 138 and/or the holes 110 and into the correspondingly pre-drilledholes in the bone to hold the plate 100 on the portions of bone tomaintain a desired rotational alignment of the cut portions of bonerelative to one another. The initial screw inserted at an end of theelongated portion 142 will then be free to move longitudinally withinthe elongated portions 142 during compression of the cut bone piecestoward one another to maintain the desired rotational alignment duringthis compression. The saw 250 includes 2 parallel blades 252, 254 whichpermit a user to make two simultaneous parallel cuts to remove thedesired amount of bone in a single precise action.

As shown in FIG. 1, the plate 100 extends longitudinally from a proximalend 102 to a distal end 104 and includes a first surface 106 which, whenin an operative position, faces away from the bone and a second surface108 which, when in an operative position, faces the bone. The plate 100includes a plurality of holes including a three-part combination hole110, a two-part combination hole 138 and a locking hole 148. The plate100 may include a low profile with tapered and/or rounded proximal anddistal ends 102, 104 along with rounded edges to prevent irritation tosurrounding tissue. The plate 100 is also pre-bent at an angle ofapproximately 4° relative to a longitudinal axis thereof to achievecompression at an opposite cortex. The plate 100 may be formed of anybiocompatible material including, for example, stainless steel,titanium, etc.

In a preferred embodiment, the plate 100 is symmetrical about an axis ofsymmetry 150 which extends substantially perpendicularly through amidpoint thereof along a length of the plate 100. Thus, the plate 100includes a proximal portion 152 proximal of the axis of symmetry 150that is substantially symmetrical to and/or a mirror image of a distalportion 154 distal of the axis of symmetry 150. It will be understood bythose of skill in the art that the symmetrical plate 100 is preferred sothat the plate 100 may be positioned along the bone in eitherorientation. It will also be understood by those of skill in the artthat since the plate 100 may be positioned in either orientation alongthe bone, the terms “proximal” and “distal” as used herein, do not referto a particular end of the plate 100, but are used to refer to endswhich, when in an operative position, are oriented toward the proximaland distal ends of the bone, respectively. In this preferred embodiment,the plate 100 includes two of the three-part holes 110, two of thetwo-part holes 138 and two of the locking holes 148. In particular, afirst three-part hole 110 a, a first two-part hole 138 a and a firstlocking hole 148 a may be positioned along the proximal portion 152 ofthe plate 100, while a second three-part hole 110 b, a second two-parthole 138 b and a second locking hole 148 b are positioned in acorresponding symmetrical position along the distal portion 154 of theplate 100. The first and second three-part holes 110 a, 110 b are, inthis embodiment, positioned closest to the axis of symmetry 150 whilethe locking holes 148 a, 148 b are furthest from the axis of symmetry150 and closest to the proximal and distal ends 102, 104, respectively.However, those skilled in the art will understand that different numbersof any of these types of holes may be employed to suit the requirementsof a given procedure without deviating from the teachings of theinvention.

As shown in FIGS. 2-4, the three part-hole 110 includes a first portion112, a second portion 114 and a third portion 116. The first and thirdportions 112, 116 define opposing longitudinal ends of the three-parthole 110 with the first portion 112 and the third portion 116 connectedvia the second portion 114. The first portion 112 is defined by apartial circular opening, which tapers radially inward from the firstsurface 106 toward the second surface 108 in a substantially conicalshape. The first portion 112 includes threading 118 along an innersurface 120 thereof and is adapted and configured to receive a firsttype of bone fixation element 122 (e.g., a locking screw) therethroughalong a central axis of the first portion 112, as shown in FIGS. 5A-5B.As would be understood by those skilled in the art, the threading 118engages a correspondingly threaded head portion 124 of the first bonefixation element 122 as the head portion 124 is rotated therein aboutthe central axis.

The second portion 114 and the third portion 116 together define asubstantially elongated portion of the three-part hole 110 that isadapted and configured to receive a second type of bone fixation element126 (e.g., a cortex screw) therethrough at any desired angle between 0°and 45° relative to an axis which is substantially perpendicular to asurface of a bone on which the plate 100 is positioned without screwhead prominence. The second portion 114 extends between the firstportion 112 and the third portion 116, including radially opposed curvedwalls 130 that taper from the first surface 106 to the second surface108. The second type of bone fixation element 126 may be inserted intothe second portion 114 along the central axis thereof until acorrespondingly shaped (e.g., spherical) head portion 128 of the secondbone fixation element 126 is seated between the curved walls 130 of thesecond portion 114, as shown in FIGS. 6A-6B. The curved walls 130 areshaped to receive the head portion 128 and prevent the head portion fromextending past the first surface 106. The third portion 116 may overlapwith the second portion 114, transitioning smoothly therefrom such thatthe second type of bone fixation element 126 may be insertedtherethrough at an angle up to 45° relative to a central axis thereof.The third portion 116 includes a first inner wall 132 extending into theplate 100 from the first surface 106 to a second inner wall 134extending from a bone facing end of the first inner wall 132 to thesecond surface 108. The first inner wall 132 forms a continuous surfacewith the curved walls 130 of the second portion 114 to accommodate thehead portion 128 at a desired angle relative thereto. The second innerwall 134 extends radially outward from the first inner wall 132 to thesecond surface 108 to accommodate a shaft portion 136 of the second typeof bone fixation element 126 at any desired angle up to a maximumangulation. For example, in this embodiment, the second inner wall 134extends outward from the first inner wall 132 along a longitudinal axisof the plate 100 at an angle of 45°, as shown in FIGS. 7A-7B, permittingthe second type of bone fixation element to be inserted therethrough atany angle relative to the surface of the bone between perpendicular and45°. As will be described in more detail below, when the bone is to beshortened via cuts which are angulated relative to the transverse, it ispreferable to make the cuts at an angle no greater than the maximumangulation of the second type of bone fixation element in the thirdportion 116 of the hole 110. This allows the user to insert the secondtype of bone fixation element therethrough along an axis perpendicularto the cut in the bone.

The two-part hole 138 includes a first portion 140 and a second portion142. The first portion 140 in this embodiment is substantially similarto the first portion 112 of the three-part hole 110 and is adapted andconfigured to receive the first type of bone fixation element 122 alonga central axis thereof to engage with the head portion 124 of the bonefixation element 122 via a threading 144 therein. The second portion 142defines a substantially elongated slot including a curved inner wall 146that tapers from the first surface 106 toward the second surface 108.

The locking hole 148 includes threading (not shown) along an innersurface thereof for engaging a threaded head portion of a bone fixationelement such as a locking screw. The locking holes 148 may be positionedproximate the proximal and distal ends 102, 104 of the plate 100 toanchor the plate 100 to the bone, fixing the plate 100 relative thereto.A first portion of the locking hole 148 extending into the plate 100from the first surface 106 tapers radially inward toward the secondsurface 108 to correspond to a shape of the head portion of the lockingscrew.

It will be understood by those of skill in the art the plate 100 may bemanufactured in a variety of lengths including any combination of theholes 110, 138 and 148 described, in a preferably symmetric pattern. Forexample, a shorter 6-hole plate 100, as shown in FIG. 1, may include twothree-part combination holes 110 a, 110 b, two two-part combinationholes 138 a, 138 b and two locking holes 148 a, 148 b positioned along alength of the plate 100 in a symmetric pattern. In a longer 8-hole plate100, as shown in FIG. 8, the plate 100 includes two non-elongatedtwo-part holes 158 a, 158 b, the non-elongated two-part hole 158 apositioned along the proximal portion 152 of the plate 100 while thenon-elongated two-part hole 158 b is positioned in a correspondingsymmetrical position along the distal portion 154. Each of thenon-elongated two-part holes 158 a, 158 b may include a first portion160 and a second portion 162 that are substantially similar to thetwo-part hole 138. However, the second portion 162 is non-elongated.Those skilled in the art will understand that, depending on the intendeduse of a particular plate, the holes need not be distributedsymmetrically along a length thereof.

According to an alternate embodiment, as shown in FIGS. 9-10, a plate100′ may be substantially similar to the plate 100, including athree-part combination hole 110′. Similarly to the plate 100, thecombination hole 110′ includes a first portion 112′, a second portion114′ and a third portion 116′. However, unlike the hole 110 of the plate100, the second and third portions 114′, 116′ are not provided with asmooth transition therebetween. Rather, the second and third portions114′ and 116′ are defined by separate distinct rounded openings suchthat a bone fixation element may only be inserted through one of thesecond portion 114′ and the third portion 116′. Thus, the bone fixationelement may be inserted thereinto only along one of a central axis ofthe second portion 114′ at an angle of 0° and a predefined insertionaxis of the third portion 116′, which is set at an angle (e.g., 45°)relative to a central axis of the three-part hole 110′. The hole 110′does not permit insertion of a bone fixation element therethrough at anangle between the second and third portions 114′, 116′.

As shown in FIG. 11, the drill template 200 may extend longitudinallyfrom a proximal end 202 to a distal end 204 and include a first surface206 which, when in an operative position, faces away from the bone, anda second surface 208 which, when in the operative position, faces thebone. As those skilled in the art will understand, the terms proximaland distal in regard to the drill template 200 correspond only to theorientation of the drill template 200 in its desired orientation in theexemplary procedures. In other procedures the orientation of thecomponents of the drill template may be reversed. The drill template 200includes a plurality of openings 210 extending through the drilltemplate 200 from the first surface 206 to the second surface 208. Thedrill template 200 may be manufactured in a variety of predefinedshortening lengths (e.g., 2.0, 2.5, 3.0, 4.0 and 5.0 mm) to permitpre-drilling, prior to cutting the bone. Thus, each of the openings 210is positioned along the drill template 200 at a location correspondingto a position of one of the three-part holes 110 and two-part hole 138.In a preferred embodiment, the drill template 200 includes threeopenings 210. Two of the openings 210 are positioned toward the distalend 204 of the drill template 200 while one of the openings 210 ispositioned toward the proximal end 202—i.e., at a location correspondingto a portion of the bone which will be on the opposite side of the cutfrom the portion of the bone into which holes will be drilled from thefirst two openings 210. For example, a first one 210 a of the threeopenings 210 corresponds to a position of the three-part hole 110 alongthe distal portion 154 of the plate 100 while a second one 210 b of theopenings 210 corresponds to a position of the two-part hole 138 b on thedistal portion. A third opening 210 c corresponds to a proximal end 146of the two-part hole 138 a extending through the proximal portion 152.

The openings 210 are preferably sized and shaped to received a guidewire 240, as shown in FIG. 12, and/or a drill tip therethrough. Thedrill template 200 further includes protrusions 212 along the firstsurface 206, which extend from the first surface 206 about each of theopenings 210 to permit greater support along a length of the guidewire(s) 240 inserted into the openings 210. The guide wire 240 mayinclude a drill tip 242 at a distal end thereof such that holes may bedrilled in the bone via insertion of guide wires 240 through theopenings 210. The drill template 200 further comprises an undercut 214along the second surface 208 which is recessed so that the bone may befully cut through while the drill template 200 is positioned thereoverwithout having the saw 250 come into contact with the drill template200. On a lateral side 216 of the undercut 214, the drill template 200includes markings 218, 220 showing positions at which the bone should becut. For example, a first marking 218 indicates a substantiallytransverse cut (e.g., substantially perpendicular to a longitudinal axisof the bone), while a second marking 220 indicates a cut at a desiredangle (e.g., 45°) relative to the longitudinal axis of the bone. Thus,the drill template 200 may also provide a guide for the saw 250 suchthat a separate saw guide may be unnecessary when used to provide atransverse cut of the bone since the blade may be substantially alignedwith the markings 218. In cases where it is desirable to use the drilltemplate 200 in combination with a saw guide 222, as further describedbelow, the drill template 200 may include a groove 215 along the firstsurface 206 to receive a portion of the saw guide 222.

Where the drill template 200 is used to provide an oblique cut via thesecond markings 220, the system may further comprise the saw guide 222,as shown in FIG. 13-14, which may be mounted to the drill template 200to guide the saw 250 along the oblique angle markings. The saw guide 222may include at least one angled surface 224 which, when the saw guide222 is mounted to the drill template 200, is aligned with the secondmarkings 220 such that a saw 250 slid along the angled surface will cutthe bone at the predefined oblique angle (e.g., 45°). In a preferredembodiment, however, the saw guide 222 may be symmetrical, including twoangled surfaces 224 such that the saw guide 222 may be mounted to thedrill template 200 to permit the bone to be cut at an oblique angle atindicated markings 220 on both sides of the drill template 200 dependingon which side the saw guide 222 is mounted. The saw guide 222 mayinclude an attachment element 228 extending therefrom such that theattachment element 228 may be received within the groove 215 to preventrotational movement of the saw guide 222 during the cutting. Theattachment element 228 may be mounted within the groove 215 of the firstsurface 206 of the drill template via a screw 226 that is insertedthrough an opening 230 of the attachment element 228 to be coupled tothe first surface 206 of the drill template 200. The saw guide 222should be attached to the drill template 200 such that the angledsurface 224 is aligned with the markings 220 of the drill template 200.In an alternate embodiment, the saw guide 222′ may be mounted to thelateral side 216 of the drill template 200 via a pin 226′, as shown inFIG. 15, such that an angled surface 224′ may be aligned with the secondmarkings 220.

The saw 250, as shown in FIG. 16, comprises a first blade 252 and asecond blade 254, each of which is substantially planar and fixedrelative to the other such that the first blade 252 and the second blade254 are substantially parallel to one another. The first and secondblades 252, 254 include sharp, bone-cutting distal edges 256, 258,respectively. The sharp distal edges 256, 258, may include teeth 260,262, respectively, or other features facilitating the cutting of bone aswould be understood by those skilled in the art. The saw 250 may bemanufactured in any of a variety of sizes for both transverse andoblique cuts in which the first and second blades 252, 254 are separatedfrom one another by a predefined distance corresponding to thepredefined shortening lengths of the drill template 200 illustrated viathe markings 218, 220. The parallel first and second blades 252, 254provide a precise parallel cut of the bone in a single cutting actionvia an oscillating action that drives the saw 250. The saw 250 may beoscillated perpendicular to a longitudinal axis thereof, driving thefirst and second blades 252, 254 through the bone.

According to an exemplary surgical technique, as shown in FIGS. 17-23, acut is made in a bone such that the bone may be fixed using the plate100. As shown in FIG. 17, the drill template 200 is positioned along thebone, preferably along an inner edge of a middle to distal third of thebone (e.g., the ulna) such that the distal end 204 of the drill template200 faces a distal end of the bone and the proximal end 202 faces aproximal end of the bone. The drill template 200 may be fixed to thebone via guide wires 240 inserted through two or more of the openings210. The guide wire 240 is inserted in a manner which drills a hole in acorresponding position along the bone via the drill tip 242. It will beunderstood by those of skill in the art that this pre-drillingfacilitates proper alignment of the bone once the bone has been cut.Where a user desires to make a transverse cut through the bone, thefirst and second blades 252, 254 of the blade 250 are aligned with thefirst markings 218 indicated on the drill template 200, as shown in FIG.18. However, where the user desires to the make an oblique cut, the usermay attach the saw guide 222 to the drill template 200 and align theangled surface 224 with the second markings 220 such that the saw 250may be slid therealong, as shown in FIG. 19.

The saw 250 is pressed into the bone to make parallel transverse and/oroblique cuts in the bone. Once the bone has been cut and the cut portionof the bone removed, the drill template 200 is removed, whilemaintaining insertion of the guide wires 240 in the bone. Upon removalof the drill template 200, the plate 100 is slid over the guide wires240 onto the bone such that each of the guide wires 240 is received in acorresponding one of the holes 110 and 138 of the plate, as shown inFIG. 20. As shown in FIG. 21, the guide wire 240 initially inserted intothe opening 210 a which corresponds to the three-part hole 110 b of theplate 100, is then removed so that a first one of the second type ofbone fixation elements 126 may be inserted therethrough. The guide wire240 initially inserted into the opening 210 b is then removed, as shownin FIG. 22 so that a second one of the second type of bone fixationelements 126 may be inserted into the corresponding two-part hole 138 balong the distal portion 154 of the plate 100.

Finally, the last guide wire 240 is removed, as shown in FIG. 23, and athird one of the second type of bone fixation elements 126 is insertedinto the proximal end 156 of the two-part hole 138 a on the proximalportion 152 of the plate 100 and through the pre-drilled hole in thebone. Compression is applied to the bone such that a proximal portion ofthe bone is moved toward a distal portion of the cut bone until the twoportions of bone are in a desired spatial relation to one another (e.g.,contacting one another at a desired rotational alignment). The proximalportion of the bone may be moved relative to the plate 100 via slidingof the bone fixation element from the proximal end 156 through theelongated second portion 142 of the two-part hole 138 a in the proximalportion 152 of the plate 100. Fixation of the bone is then completed byinserting bone screws into the bone through remaining holes of the plate100. For example, the first type of bone fixation element 122 (e.g.,locking screws) may be inserted into the locking holes 148 a, 148 b andone of the first and the second types of bone fixation elements 122, 126(e.g., locking screw, cortex screw) may be inserted into the three-parthole 110 a, as shown in FIG. 24. Where an oblique cut was made in thebone, the second type of bone fixation element 126 may be insertedthrough the three-part hole 110 a, at an angle relative to the centralaxis thereof, such that the shaft portion 136 extends through obliquelycut surfaces of the bone, as shown in FIG. 25.

According to a second exemplary embodiment of the present invention, asshown in FIGS. 26-32, a plate 300, as shown in FIG. 26 may be used tofix portions of a bone that have been cut using a drill guide 400 and asaw blade 450. The plate 300, as shown in FIG. 26, is substantiallysimilar to the plate 100, as described above, extending longitudinallyfrom a proximal end 302 to a distal end 304. Similarly to the plate 100,in a preferred embodiment, the plate 300 includes a proximal portion 352and a distal portion 354 which may be substantially symmetrically shapedrelative to one another about an axis of symmetry 350. The plate 300,however, does not include three and two-part combination holes. Rather,the plate 300 includes a plurality of locking holes 310 extendingtherethrough from a first surface 306 to a second surface 308 along boththe proximal and distal portions 352, 354. For example, the proximalportion 352 may include a plurality of locking holes 310 a and thedistal portion 354 may also include a plurality of locking holes 310 b.As shown in FIG. 26, however, the plurality of locking holes 310 a, 310b are not required to mirror one another along the proximal and distalportions 352, 354. Additionally, the proximal portion 352 and the distalportion 354 may each include an elongated hole 338 a, 338 b,respectively.

The locking holes 310 may be substantially similar to the locking holes148, including threading 318 extending about an inner surface thereoffor engaging a threaded head portion of a bone fixation element. Theelongated hole 338 may be elongated in a longitudinal direction,including an inner surface 346 that tapers from the first surface 306toward the second surface 308. The inner surface 346 may besubstantially spherically shaped to receive a correspondingly shapedhead portion of a bone fixation element such as, for example, a cortexscrew.

As shown in FIG. 27, the drill template 400 may be substantially similarto the drill template 200, as described above, extending from a proximalend 402 to a distal end 404 and including openings 410 corresponding tothe positions of the locking holes 310 b in the distal portion 354 andthe elongated hole 338 a in the proximal portion 352. Similarly to thedrill template 200, the drill template 400 may be positioned along thebone to pre-drill holes in the bone using a guide wire or a drill tip440 inserted through the openings 410 at positions corresponding to thepositions at which the holes 310 b, 338 a extending through the plate300 will be located when the plate 300 is in a desired position over thesevered portions of the bone after it has been cut. The saw 450, whichis substantially similar to the saw 250, may be subsequently used tomake a parallel transverse and/or oblique cut in the bone using a sawguide 422 which may be positioned against the bone in the same mannerdescribed above. As shown in FIG. 28, the saw guide 422 may bepositioned against the bone to make a substantially transverse cuttherethrough. Alternatively, the saw guide 422 includes angled surfaces424 such that the saw 450 may be moved against the angled surface to cutthe bone along a predefined oblique angle relative to the axis of thebone.

A surgical technique according to the system of the second exemplaryembodiment is substantially similar to the technique described above.Subsequent to cutting the bone, the drill template 400 is removed andthe plate 300 is slid over the guide wires 440 and positioned along thebone. Alternatively, the guide wires and/or drill tip 440 may be removedafter the holes have been pre-drilled in the bone. Upon removal of theguide wires 440, bone fixation elements 322 of the first type (e.g.,locking head screws) are inserted into the locking holes 310 b along thedistal portion 354, as shown in FIG. 29 and a bone fixation element 326of the second type (e.g., a cortex screw) may be inserted into aproximal end 356 of the elongated hole 338 a in the proximal portion352. Compression is then applied to the bone to move a proximal portionof the bone toward a distal portion thereof until the proximal anddistal portions of the severed bone are in a desired spatial relation toone another, as shown in FIG. 30. During this movement, the bonefixation element 326, which was inserted through the proximal end 356 ofthe elongated hole 338 a, slides distally within the elongated hole 338a toward a distal end 358 thereof. For additional compression, a secondbone fixation element 326 may be inserted into the proximal end 356 ofthe elongated hole 338 a, as shown in FIG. 31. To provide furtherfixation, additional bone fixation elements 322 may be inserted into theremaining locking holes 310 a, as shown in FIG. 32.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the structure and themethodology of the present invention, without departing from the spritor the scope of the invention. Thus, it is intended that the presentinvention cover the modifications and variations of this inventionprovided that they come within the scope of the appended claims andtheir equivalents.

1-23. (canceled)
 24. A bone plate, comprising: a body extending along alongitudinal axis from a proximal end to a distal end and including afirst surface which, when the bone plate is in an operative positionalong a bone, faces away from the bone, and a second surface which, whenthe bone plate is in the operative position, faces toward the bone; anda three part combination hole extending through the body from a firstsurface to the second surface, a first portion of the three partcombination hole defining a first portion axis and being configured tolockingly engage a head of a first bone fixation element to lock thefirst bone fixation element along the first portion axis, a secondportion of the three part combination hole being shaped to engage a headof a second bone fixation element to permit insertion of the second bonefixation element only along a second portion axis substantiallyperpendicular to the longitudinal axis, a third portion of the threepart combination hole smoothly transitioning from the second portionwith a shape of the third portion gradually changing along a length ofthe third portion to angulate an axis along which a second bone fixationelement will extend when inserted therethrough so that an angulation ofa second bone fixation element inserted into the third portion variesalong the length of the third portion to a maximum angulation relativeto the second portion axis at a second end of the third portion furthestfrom the second portion.
 25. The bone plate of claim 24, wherein thefirst portion includes a threading for engaging a threaded head of thefirst bone fixation element.
 26. The bone plate of claim 24, wherein thesecond portion includes a curved wall tapering from the first surface tothe second surface.
 27. The bone plate of claim 26, wherein the thirdportion includes a first wall extending from the curved wall to form acontinuous surface therewith so that a head of the second bone fixationelement may be seated therealong when the bone fixation element is atthe user-selected angle.
 28. The bone plate of claim 27, wherein thethird portion includes a second wall extending from an end of the firstwall toward the second surface to accommodate a shaft portion of thesecond bone fixation element at the maximum angulation.
 29. The boneplate of claim 24, wherein the maximum angulation is 45 degrees.
 30. Thebone plate of claim 26, wherein the curved wall is shaped so that, whenthe second bone fixation element is inserted therein along the secondportion axis, the head of the second bone fixation element does notextend proximally of the first surface.
 31. A system for treating abone, comprising: a bone plate including a three part combination holeextending therethrough from a first surface which, in an operativeposition, faces away from a bone, to a second surface which, in theoperative position, faces toward the bone, the three part combinationhole including a first portion defining a first portion axis andincluding a threading thereabout, a second portion shaped to engage ahead of a bone fixation element to permit insertion of the bone fixationelement only along a second portion axis substantially perpendicular tothe longitudinal axis, and a third portion smoothly transitioning fromthe second portion with a shape of the third portion gradually changingalong a length of the third portion to angulate an axis along which thebone fixation element will extend when inserted therethrough so that anangulation of a bone fixation element inserted into the third portionvaries along the length of the third portion to a maximum angulationrelative to the second portion axis at a second end of the third portionfurthest from the second portion; and a first bone fixation elementinsertable into one of the second portion and the third portion.
 32. Thesystem of claim 31, wherein the first bone fixation element is a cortexscrew.
 33. The system of claim 31, further comprising a second bonefixation element insertable through the first portion of the three partcombination hole along the first portion axis.
 34. The system of claim33, wherein the second bone fixation element is a locking screw.
 35. Thesystem of claim 31, wherein the second portion includes a curved walltapering from the first surface to the second surface.
 36. The system ofclaim 35, wherein the third portion includes a first wall extending fromthe curved wall to form a continuous surface therewith so that a head ofthe first bone fixation element may be seated therealong when the bonefixation element is at the user-selected angle.
 37. The system of claim36, wherein the third portion includes a second wall extending from anend of the first wall toward the second surface to accommodate a shaftof the first bone fixation element at the maximum angulation.
 38. Thesystem of claim 31, wherein the maximum angulation is 45 degrees. 39.The system of claim 35, wherein, when the head of the first bonefixation element is seated in the curved wall, the head of the firstbone fixation element does not extend proximally of the first surface.